title: Incidence of microemboli and correlation with platelet inhibition in aneurysmal flow diversion.
abstract: Flow-diverting stents have been associated with embolic and hemorrhagic complications, but the rate of procedure-related microemboli is unknown. Using transcranial Doppler sonography, we measured the rate of microemboli in 23 patients treated with flow-diverting stents. Patients received preprocedural dual antiplatelet medications and intraprocedural heparinization. Point-of-care platelet reactivity testing was performed before the procedure, and nonresponders (>213 P2Y12/ADP receptor reactivity units) received additional thienopyridine. Transcranial Doppler sonography was performed within 12-24 hours. Microemboli were detected in 3 patients (13%), 2 of whom were initially nonresponders. There was no association between the presence of microemboli and procedural or neurologic complications, aneurysm size, number of stents, or procedure time. Eight procedures (34.8%) required additional thienopyridine for inadequate platelet inhibition, and 3 required further treatment for persistent nonresponse to point-of-care platelet reactivity testing. There were 6 technical and 2 postoperative complications; none were associated with inadequate platelet inhibition or microemboli. The combination of routine point-of-care platelet reactivity testing and postprocedural microembolic monitoring may help identify patients at risk for thromboembolic complications after flow-diverting stents.
authors.affiliation: Departments of Neurological Surgery.
authors.forename: M R
authors.initials: MR
authors.lastname: Levitt
authors.forename: B V
authors.initials: BV
authors.lastname: Ghodke
authors.forename: D K
authors.initials: DK
authors.lastname: Hallam
authors.forename: L N
authors.initials: LN
authors.lastname: Sekhar
authors.forename: L J
authors.initials: LJ
authors.lastname: Kim
mesh_terms: D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors